New-Canada-Eng-House Service Provider Membership Application

First Name*
Last Name*
Title*
Note: The Primary Contact is the person who will be the recipient of information from ISSA.
Email*
Company Name*
Mailing Address (Reminder: Mailing address should not be a personal address)*

Street Address

Street Address Line 2

CityProvince / Territory

Postal Code
Company Email*
Company Email will be used in the ISSA Membership Directory
Company Telephone*
Toll Free
Company Fax
Company fax will be used in the ISSA Membership Directory
Company Website

Contacts

Please list key employees to receive communications from ISSA Canada regarding industry news, events and educational opportunities:
First Name
Last Name
Title
Email
First Name
Last Name
Title
Email
First Name
Last Name
Title
Email

PAYMENT OF DUES

A remittance of one (1) full year’s dues is to accompany this application. Dues are billed annually based on the date you originally joined. Dues are non-fundable and quoted in Canadian Dollars (not including HST).
Sub Total
13% H.S.T.
ISSA Scholars Contribution – Suggested $50
Coupon Code
Total

Contacts